Autism Society of Greater Orlandos 2012 Autism Walk & Family Fun Day Information Sheet

The Autism Society of Greater Orlando is hosting its 7th Annual Autism Walk & Family Fun Day inside the Orange County Convention Centers South Concourse on Saturday, June 30, 2012 from 9:00 AM 12:00 PM. We would like to invite everyone out to support ASGO and the families affected by autism. 100% of the proceeds will stay right here in the Central Florida area. Registration includes: Admission into the event Event t-shirt (while supplies last) Free parking Air conditioned facility

Other Activities include: Access to local vendors Kids activities at every vendor booth Raffle & Silent Auction including gift cards, hotel stays and autographed sports memorabilia. Massages Sports Corner with great games and prizes Moon bouncers Special Guests including Ronald McDonald, Stuff, Globie the Bumble Bee, Magic Dancers, & others. All are subject to change w/out notice.

Schedule of event:

Walker Registration and Vendor areas open at 9:00 AM. The walk will start at approximately 10:00 AM.

For additional information or to register, contact ASGO at 407-855-0235, via email at dlorman@asgo.org or visit our website at www.asgo.org.

Please complete one form for each participant regardless of age.

_____ ________________________ Prefix First Name ____________________________________ Last Name

ASGOs 7th Annual Autism Walk & Family Fun Day Participant Registration Form

Mailing Address _____________________________________ _____________ City State ____________________________________ Phone _____Male ______Female _____________ Zip

_____________________________ E-Mail Address Birth Date ____/____/_____

Team/Individual Information: ___ I am registering as an individual. ___ I am registering as part of a team. Team name: ________________________ ASGO Affiliation: ____ I am a member of ASGO ____ I would like to receive membership information Cost: ____ $10.00 Participants with team/family pledges ____ $25.00 Participants with no pledges ____ $5.00 Dedication Lane Footprint (please enclose separate form) Please circle appropriate t-shirt size: CS CM CL AS AM AL XL XXL XXXL PLEASE NOTE: T-shirts are guaranteed to those pre-registered by April 1, 2011. Payment method: Cash, checks payable to the ASGO, or Visa/Master Card. If you wish to charge your tickets, please fill in the information below: I, _____________________, hereby authorize the Autism Society of Greater Orlando to charge my credit card number ________________________________ with a v-code

of ________ (3 digit number on back of the credit card) and an expiration date of ____________, for a total of $____________. ___________________________________ Signature Completed form should be faxed to 407-855-5129 or mailed to: ASGO 12720 S. Orange Blossom Trail #8 Orlando, FL 32837

ASGOs Autism Walk & Family Fun Day Pledge Sheet

The Autism Society of Greater Orlando is a 501(c)(3) not for profit organization dedicated to serving the more than 5,000 Central Florida families living with some form of Autism. Every dollar raised at this event will stay here to support our families living with autism today. Please visit our web site at www.asgo.org to see more about autism and our organization. Participant name__________________________ Address__________________________________ City___________________________State______________Zip___________________ Daytime Phone Number___________________________________________________ Total $ Collected____________________ Please make checks Payable to the Autism Society of Greater Orlando. Mastercard & Visa are also accepted. If paying by a charge card, please include the credit card number & expiration date) Name ______________________________________________Donation $__________ Name ______________________________________________Donation $__________ Name ______________________________________________Donation $__________ Name ______________________________________________Donation $__________

Name ______________________________________________Donation $__________ Name ______________________________________________Donation $__________ Name ______________________________________________Donation $__________ Name ______________________________________________Donation $__________ Name ______________________________________________Donation $__________ Name ______________________________________________Donation $__________ Name Name Donation $ Donation $ Please photocopy this form to include additional sponsors.

ASGOs AUTISM WALK & FAMILY FUN DAY WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
In consideration of being permitted to participate in the ASGO Autism Walk (the Event) as a walker, volunteer or in any other capacity, I, for myself and for my heirs, next of kin, assigns and personal representatives: 1. Represent that I am qualified, in good health and in proper physical condition to participate in the Event. If at any time during my participation in the Event I feel like my physical condition no longer allows me to participate safely or I believe the Event becomes unsafe, I will immediately stop my participation. 2. Acknowledge and understand fully that there are risks and dangers of serious bodily injury and death that could result from my participation in the Event. The risks include, but are not limited to, weather, equipment, actions of other people, including coaches, event officials, and other participants and volunteers, spectators, sponsors, event monitors, producers, organizers, police and municipal workers and operators of motor vehicles in or around the area in which the Event will take place. These risks are inherent in athletics and events that involve large numbers of people and take place in public places. Being aware of these risks and dangers, I have voluntarily elected to participate in the Event and I FULLY ACCEPT AND ASSUME ALL RISKS AND ALL RESPONSIBILITY FOR ANY INJURY, LOSSES AND DAMAGES TO PERSON OR PROPERTY THAT I INCUR AS A RESULT OF MY PARTICIPATION IN THE EVENT.

3. HEREBY AGREE NOT TO SUE AND TO RELEASE, DISCHARGE, WAIVE, HOLD

HARMLESS AND TO INDEMNIFY The Autism Society of Greater Orlando and its affiliates and their officers, directors, employees, volunteers, sponsors, advertisers, participants, agents and representatives, and all other sponsors, organizers, volunteers, officials, medical workers, producers, lessors and organizers and any involved municipalities or other public entities and each of the directors, officers, employees, agents representatives, successors, heirs and assigns of any of the above individuals and entities (collectively and individually Releases) FROM AND AGAINST ALL LIABILITIES, CLAIMS, DEMANDS, LOSSES, DAMAGES, SUITS AND PROCEEDINGS, REGARDLESS OF THE CAUSE, INCLUDING THE NEGLECT OR CARELESSNESS OF ANY RELEASEE, ARISING OR RESULTING FROM MY PARTICIPATION IN THE EVENT. 4. I irrevocably grant to The Autism Society Of Greater Orlando the right and permission to use my recorded voice, image and likeness in any medium including, without limitation, video, photograph, film and tape, for any lawful purpose I have read this agreement and understand that I have given up substantial rights by agreeing to it. I have agreed to this agreement freely and voluntarily without any inducement or assurances of any nature. I INTEND THIS TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY THE LAW, EVEN THOUGH THAT LIABILITY MAY ARISE FROM THE NEGLIGENCE OR CARELESSNESS OF THE RELEASEES LISTED ABOVE, and I agree that if any portion of this agreement is held to be invalid, the remaining portion of the agreement shall continue to be in full force and effect.

By_______________________________________________ Date ____/_____, 20___ Witness Signature __________________________________ Date ____/_____, 20___